Best Treatment for Localized Prostate Cancer Remains Unclear

By Will Boggs, MD

NEW YORK FEB 14, 2008 (Reuters Health) - Current evidence cannot definitively identify the best approach to clinically localized prostate cancer, according to findings of a systematic review reported in a February 4th early publication of the Annals of Internal Medicine.

"Determining the "best treatment" for early stage prostate cancer is not currently possible due to limitations in the evidence and the different values that patients may place in various outcomes (e.g., worry about long-term tumor progression versus concern about treatment-related side effects)," Dr. Timothy J. Wilt from the Minneapolis VA Center for Chronic Disease Outcomes Research, Minnesota, told Reuters Health.

Dr. Wilt and associates investigated the comparative short- and long-term benefits and harms of therapies for clinically localized prostate cancer and how patient and tumor characteristics affect the outcomes of these therapies.

Radical prostatectomy tended to be more effective in reducing death, recurrence, and distant metastases than watchful waiting or external beam radiation therapy, the authors report, but radical prostatectomy was associated with more adverse events and sexual dysfunction.

Neoadjuvant androgen deprivation therapy did not appear to improve outcomes of radical prostatectomy alone, the report indicates, and brachytherapy appeared to offer no improvement in biochemical failure or progression.

There was no apparent difference in overall outcomes between laparoscopic and robotic-assisted radical prostatectomy, the researchers note, and intensity-modulated radiation therapy provided similar biochemical-free survival to that with conformal radiation therapy.

"Treatment options include surgery, radiation, hormonal therapy, and watchful waiting," Dr. Wilt said in summarizing the findings. "Each has potential benefits and risks. Treatment decision making should incorporate patient and provider preferences regarding potential effectiveness and harms of treatment versus the likelihood of tumor progression in the absence of treatment."

"Completion of randomized controlled treatment trials is necessary to provide high quality information necessary to assess the comparative risks and benefits of prostate cancer treatments and help patients/providers in determining their preferred treatment options," Dr. Wilt said.

"Ongoing trials such as PIVOT (surgery vs. watchful waiting) are scheduled for completion in early 2010," Dr. Wilt said. "ProTecT will finish later than that."

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